Preparing for Therapy

So you are ready for therapy but don't know what to expect. What's the difference between all the mental health professionals?

A psychologist has a PhD, they use a variety of therapies but do not prescribe medications. They usually run programs, in rank they compare to captains. A psychiatrist is a medical doctor who specializes in mental health, they use a variety of therapies and prescribe medication. They often run departments, they would be considered a colonel or appropriate rank.

Therapists would be the high-ranking Non-commissioned officers the military could not run without. They are usually clinical social workers with a master's degree and often have specialties. My therapist is a nurse-practitioner.

You may need a Marriage and Family Therapists for help with your partner and relationship. But, more than likely if you are reading this you will need a therapist who practices evidence-based therapies to treat posttraumatic stress disorder, military sexual trauma and traumatic brain injury. In therapy you will need an empathetic hand to guide you through the wreckage of your mind.

Empathy is the ability to identify, internalize and experience another's emotional state. It's imperative to find a therapist you can connect with. The nature and structure of trauma leaves internal conflicts; the kernel of trauma-based disorders rest in the most recessed parts of our minds.

The most important aspect of therapy will be an empathetic connection with your therapist, a therapeutic window between the therapist and the patient to reach the deepest compartments. To access this information safely, we must bond with our treatment provider.

To begin the journey of recovery we must find a therapeutic window into our minds substrate. Without developing a rapport with your therapist, therapy will not work. Read that again.

Become an advocate for yourself and learn some basic information on how the Veterans Administration works. You can fire any doctor or therapist in the VA by going to the counter and asking for a Change of Provider form.

Write the reason you don't want this provider and you don't trust them. Generally it will take up to 3 months to get a new appointment so make sure you want to change. Go to at least 3 or 4 visits before you decide to fire your mental health practitioner.

I fired a therapists because she talked about her issues and was more depressed me. I fired a psychiatrist due to her inability to discuss my medications with me or her unwillingness to listen to what I had to say. I've changed therapists because they were not certified in Cognitive Processing Therapy (CPT).

There are many kinds of therapy and the one you will probably engage in the most is psychotherapy or talk therapy. Talk therapy consists of sharing about psychological distresses, social, life in general and family issues. The therapist listens, gives feedback and psychoeducation on your condition along with teaching coping skills to manage symptoms.

Talk therapy focuses on maintaining equilibrium and balance in life. The most effective treatments for the mentally wounded with the diagnosis of PTSD, MST and TBI is evidence-based therapies. The front-line treatments are Cognitive Behavioral Therapy (CBT), Cognitive Processing Therapy (CPT) and Exposure Therapy (ET). Ask your mental health provider if they use these therapies and if they have certification.

We'll cover two, since they are the most used. CBT examines the relationships between thoughts, feelings and behavior. By identifying beliefs that lead to self-destructive behaviors the therapist can offer coping strategies to help change thinking patterns over time. The therapies will be problem-focused and goal-directed for symptom reduction. Expect to have homework and if you want to heal actively participate.

Cognitive Processing Therapy, an exposure therapy, focuses on accessing trauma memories, identifying and challenging faulty beliefs about the event and resulting over-generalized beliefs in self. According to Cognitive Theory, trauma impacts our belief structures and how we categorize the world.

That two types of emotions follow trauma, natural and manufactured. Natural emotions are universal such as fear, anger, joy, happiness, sadness and loss. They have a natural course to run unless we feed into them, then they can become stuck points. Manufactured feelings result from the way we interpret events and not fact based.

I know a combat medic with four tours and many medals, the purple heart included. She was unable to return to active duty because of extensive damage received from an Improvised Explosive Device. She's fighting the belief that she let soldiers down because she couldn't return to her Mobile Army Surgical Hospital and deploy outside the wire under fire where she belonged.

Cognitive Processing Therapy starts with psychoeducation about your condition and symptoms, then therapy goals and identification of stuck points, and then 12 sessions centered around challenging beliefs and meaning of the event.

The structured sessions center around identifying thoughts, feelings and stuck points associated with the event. They challenge problematic thinking and address safety, trust, power and control, esteem, intimacy and meaning. This is an exposure therapy, a writing component starts with an impact statement and then writing about the trauma again from each perspective safety, trust, power and control, esteem, intimacy and meaning. The therapist and patient will examine the writing together with worksheets and writing exercises. I've used this therapy and it's the best one so far.

Keep a therapy journal. Write a list of questions and reminders to keep track of what to talk about. Write about your insights and revelations.

Write about your feelings, thoughts and trauma. In doing so you begin to take back your mental health one session at a time. A journal will keep you from forgetting the issues you want to discuss and a place to share your inner self.

Trauma telling is an important aspect of healing, it enables us to re-contextualize our experiences and find meaning where we once thought was none.

Seconds Away From Suicide: Readily Will I Display...

On the 5th of April, I burned my wrist pretty badly while making some home-brew. My wife had the car at the time, but, before I would even call for help, I had to clean the wort off the floor (wort is beer before yeast is added). I saved all of the wort so I could finish that batch. The Ranger creed may seem like a silly mechanism to discuss suicide, but the Ranger creed is what saved my life when I had loaded gun in my hand. This example of me cleaning up my mess before even calling someone in order to go to the emergency room illustrates just how the sixth stanza of the Ranger is webbed into fabric of my being. It is what prevented me from taking my own life.

Readily will I display the intestinal fortitude required to fight on the the Ranger objective and complete my mission, though I be the lone survivor. Rangers lead the way.

After I came home from the Surge, I could no longer conceal the problems I had for years. In crowds, I got so overwhelmed that I would almost pass out. I had to stop driving because I almost ran off the road twice, when I thought there were IEDS. Panic attacks almost made me lose consciousness. The mTBI symptoms were worse then, limited spatial awareness and vertigo characterized my life. When my neurologist recommended an inpatient program, my battalion executive officer told the personnel officer that he did "not have time to deal with a Captain with PTSD and mTBI," while I sat outside his office. I was the most battle tested officer in that battalion, and I felt like Boxer from Animal Farm: once I was used up, my battalion was happy to ship me off to the glue factory. My doctor stuck to his guns and I went to an inpatient program in Richmond, Virginia, and then in Salisbury, North Carolina. During my hospitalization my ex-wife decided that her chemistry professor was a better choice.

Needless to say, life was not going well and I was leaving the Army just days after getting out of a hospital. I was packing up my home to put it on the market when I looked at a Beretta pistol. Why not end it all right now? The unit I fought in for years thought I was a piece of shit, my family had not even seen me after I came home, and my wife was shopping around for a replacement. I still had the hospital bracelet on and now I was about to be on the street alone. No pay, no purpose, no family, no support at all. Just alone in my thoughts. I cocked the gun, but before I could lift it up my Ranger brain took to action.

The flood of the, stress chemical, cortisol, was something I had become accustomed to using in combat. In most cases you use the surge of cortisol to fight or fly, but as an officer I employed it to think through outcomes. When I held that gun in my hand I thought through what would happen. The Army would do nothing... I would just be another number. Maybe friends might find out, and be more sensitive when they had soldiers struggling with PTSD.  Probably not though, they always had their soldiers' best interests at mind. My mother would be devastated, but my father would just write my suicide into his latest narrative of war making me a sinner, and turning me against God.

Serendipitously, my boots from Ranger school were in my eye-line and reminded me of what I was capable of handling. Sure I wanted all of that to end, but I felt that way in Ranger school too. I used to say to myself, "I don't want to quit, I just want this to end." When you're walking in the middle of a swamp no one is coming in with a jungle penetrator to take you home. I would just make it to the next rest halt. This was the same, but what was the point? What was my purpose anymore? I left the Army because I wanted to make a difference with my pen. All of my "disabilities" were going to make that nearly impossible. So you're saying there is a chance. I was never a smart Ranger anyway, I was always a tough one. Everyday I was at sick call getting something drained, taking crazy low distribution antibiotics, getting all the skin taken of the bottom of my foot, yet everyday I would smile while humming the Ranger school hymn, "I'll Fly Away."

I knew how to find my way in misery; without thought I dropped the magazine, removed all the rounds and threw them into the woods. At the time I had no idea of what my mission was, but I was damn sure going to fight onto that objective. The whole world seemed to have turned on me, but, so what, just hum that hymn, drive on and somewhere in the process I will figure out how to get better, or learn how to enjoy the suck. I kept one Ranger school boot on my desk and one on my dresser so I would always be able to remember what I was capable of overcoming.

I can't tell you why things got so bad for me, but what I do know is that I did nothing to cause it or deserve it. I certainly am not weaker than I was before. If anything I am tougher mentally than my body is physically, and I should take it easier when my body is giving me queues like "Hey stupid, your wrist has second degree burns on it... someone else can clean the floor later on."  More importantly, when you have stepped up to save your own life, every milestone gets a little sweeter. My relentless mission focus is, more often, an annoying characteristic that pushes me way too  hard, but it also brought me through the most difficult time in my life. A time when I had no support at all. Now when I hold my wife, play with my dog, drink with my friends, and work with my colleagues, I am so grateful for the man that pushed on when there was no indication that I could never make a positive impact on the lives of others again.

You can see my burn and Darby's awesomeness

When we were kids we never think that, "seconds away from suicide," would end up on our bucket list, but I am so happy that I had the courage to live on unashamed. I have been lucky enough to put more on my bucket list after that day than I would have had the courage to dream of as a child. I hated Ranger school, but, like in combat, its ideals have never let me down when the world becomes dangerous or chaotic. It is often said that the Army never trained us for coming home, and that is generally correct, but it did teach us values. Learning to translate core values into a life out of uniform saved my life, and I would be lost without things like the Army Values, Warrior Ethos, and the Ranger creed. The road home is not easy and it sucks more often than not, but that doesn't mean that its is not something you can't enjoy or find fulfilling. It certainly beats Ranger School.

Remembering The Boston Marathon Attack: There Were More Heroes than Villains Today

A Veteran from TRWB using his shirt as a bandage

It is often assumed that the memory of an event is solely based on what actually happened, rather than a process that occurs overtime and through a purposeful process. Like many other veterans, this day was harder for me because all the images of carnage conjured up memories of similar tragedies. I have been watching the images and has sent me back to the aftermaths of suicide bomber attacks on civilians. That is my weight to bear and is less important than trying to make sense of days like today. All of the television footage of the explosions do not hold a candle to what was actually experienced.

With the shock-wave of high explosives sensations of heat and concussion hit you before your brain can process the image. So the television cameras are less of  an expression of the actual experience, instead, they provide an illusion of clarity. When you see people still running forward its because their brains haven't even put two and two together yet. It is worse for the injured because they are physically affected by the injuries prior to even full rationalization of what is happening.

When you come to a location after a bombing, people have almost no understanding of their injuries. The adrenaline of the attack will cover up the pain, but there is still such a look of terror. I was just standing here and there was this loud noise, heat, pain, and I am now on the ground. The emotional shock of the event almost overpowers the physical aspects until the chemical groups that manage adrenaline fade away. Medical professionals call this the golden hour. Shell Shock was the moniker of the First World War because it speaks to the confusion and chaos that goes on in the brain in the wake of explosions like today's. These chemicals often damage memory and will always make these memories difficult without the tragic nature of their content.

Watching the images of people on the ground just looking around aimlessly illustrates how the events are much more chaotic for people present. The capturing of multiple still images does very little to capture it. Just think of the smell of it. You never forget those smells and anything that reminds me of the smell of burning flesh make me sick for weeks.

Despite the horror and misery that these poor runners and bystanders absorbed today, no justice for the terrorist(s) who did this will make it right. The important part of the narrative that will diminish over time is the human capacity for compassion illustrated by this tragedy. It is important that we remember the good that was demonstrated today. Watch the video. One person or a small group of people did this, but before the smoke cleared people were running to help. You could see some bleeding themselves and doing all they could to save others.

That doesn't make everything better, but when things like this happen it is important to note that when one or maybe ten people conspire to do something this terrible, hundreds of people will rush into that danger to help others. There is no divorcing today's attack from the tragic impact it has made on the lives of the injured, but it is another reminder that their will always be many more people rushing to help. Some people have no problem doing terrible things to innocent people, but more people will fight to help the injured. In senseless tragedies we see the worst of a few people, but the best of so many more. It doesn't make the suffering from today's events any less acute, but it does speak to the human spirit and how we can stand in the face of tragedy. In the coming weeks we are going to be bombarded with what went wrong today, and I am sure there may be some finite oversights that could have prevented this. However, there were many more good people stepping up as heroes than there were terrorists using the misery of the innocent to draw attention to their cause. We would be wise not to forget this hard earned fact, that many more first responders and bystanders did all they could to save lives today.